Neonatal Anatomy

Question 1

What is the primary determinant of systolic BP in the neonate?

Answer 1

Heart rate

Question 2

What is the formula to determine hypotension in a child older than 1 year?

Answer 2

Hypotension = SBP < 70 + (childs age in years x 2)

Question 3

Answer 3

Question 4

Infant larynx is located at C_ -C_ while the adult is located where?

Answer 4

C3-C4;
C5-C6

Question 5

In the adult, the right bromchis takes off at __ degrees and the left at __ degrees from midline. How rose s the pediatric airway differ?

Answer 5

Right = 25 degrees
Left = 45 degrees

Up to the age of 3, both bronchi take off at 55 degrees from midline

Question 6

Answer 6

Question 7

Neonatal oxygen consumption vs adult

Answer 7

6-9 mL/kg/min (neonate)
3.5 mL/kg/min (adult)

Question 8

Neonatal alveolar ventilation

Answer 8

130 mL/kg/min

Question 9

Answer 9

Question 10

Infants less than ___ weeks PCA should be admitted for 24 hr observation with an apnea monitor following anesthesia

Answer 10

60

Question 11

What can reduce the risk of postop apnea after general anesthesia, but does not take the place of admission

Answer 11

Prophylactic caffeine (10mg/kg IV)

Question 12

What is the primary muscle of inspiration

Answer 12

The diaphragm

Question 13

What 2 types of muscle fibers make up the diaphragmatic and intercostal muscles?

Answer 13

Type 1 slow-twitch (built for endurance)
Type 2 fast-twitch (built for short bursts of heavy work)

Question 14

In the neonate, what percentage of respiratory muscles are type-1 fibers?

Answer 14

25% (compared to 55% in adults)

Question 15

Answer 15

Question 16

Answer 16

Question 17

Adult hgb consists of 2 ____ & 2 ___ chains while fetal hgb consists of 2 ___ & 2 ___ chains.

Answer 17

Adult: 2 alpha & 2 beta
Fetal: 2 alpha & 2 gamma

Question 18

Answer 18

Question 19

When does HgbA start to replace HgbF? When is it complete?

Answer 19

2 months; 6 months

Question 20

What is the P50 of fetal hgb? Adult?

Answer 20

Fetal= 19mmHg
Adult= 26.5mmHg

Question 21

TBW for premature infant

Answer 21

80-90%

Question 22

When do signs of hypoglycemia manifest in the newborn?

Answer 22

< 72hrs old: < 30-40 mg/dL
> 72hrs old: < 40 mg/dL

Question 23

Tx for hypoglycemia? If seizures present?

Answer 23

IV 10% dextrose 2mL/kg.
Seizures: 4mL/kg
After bolus D10 infusion at 8mg/kg/min

Question 24

What year is normal GFR achieved? Tubular function?

Answer 24

GFR: 8-24 months
Tubular: 2yrs

Question 25

CO of newborn

Answer 25

200ml/kg/min

Question 26

Should the does of water soluble drug increase or decrease for a neonate?

Answer 26

Increase. Neonates have greater % TBW, so they require higher doses of water soluble drugs to achieve a given plasma concentration

Question 27

What is the MAC of Sevo in a 3 month old?

Answer 27

3.2% (0-6months)

Question 28

Why are neonates more sensitive to sedative-hypnotics?

Answer 28

Immature BBB

Question 29

IM dose of succ for neonates/infants? Older children?

Answer 29

Neonates/infants: 5mg/kg
Older children: 4mg/kg

Question 30

Only NDNMB that can be given IM. Dose <1yr? >1yr?

Answer 30

Roc
1mg/kg IM < 1yr
1.8mg/kg IM > 1yr

Question 31

Answer 31

Question 32

In a neonate with CDH, PIP should be kept below?

Answer 32

PIP < 25-30 cmH2O

Question 33

After diagnosis, how long is CDH repair normally delayed?

Answer 33

5-15 days

Question 34

List 3 physiologic conditions to avoid in a neonate with CDH

Answer 34

Hypoxia, acidosis, hypothermia

Question 35

Answer 35

Question 36

Causes by failure of the gut migration from the yolk sac into the abdomen

Answer 36

Omphalocele

Question 37

Caused by occlusion of the omphalomesenteric artery during gestation

Answer 37

Gastroschesis

Question 38

In the pt with pyloric stenosis, severe dehydration should be treated with a bolus of?

Answer 38

20 mL/kg 0.9%NaCl

Question 39

NEC affects which area of the bowel?

Answer 39

Terminal ileum and proximal colon